BP7352BUILDING PERMIT APPLICATI®N
Jurisdiction of City of Blair, Nebraska
Permit Fee: i ~ • ~ ~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit-
Application Date: G- S" ~ ~ Issue Date: ~JC~'~ I~
JOB ADDRESS I ~ .7e~ ~ n ~ ( ~S ~~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER ®- MAIL ADDRESS ZIP HONE
CONTRACTOR MAIL ADDRESS
3. ,~C~r'Y\ e ZIP PHONE
4. Class of Work: ~ NEW O ADDITION O REMODEL
5. Describe Work: ~-~~}C-~ .9- !~ ` WU~ ..~~C~ ,.~ ~,~~ j/1 O Finished Basement O Unfinished Basement
~~a~ c c~~e ~r~~ s ~ `l-~1~~ ~ ~ r~~ li~-e= -
6. Total Sq. Footage (Including Basement and Garage): Total Finished Area:
7. Valuation of Work: $ ?j~• ~~~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes O No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes
Side Rear
O No Waiver Approved
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. By my signature below, I acknowledge that payment
of the building permit application fee does not constitute issuance of this building
permit. I further agree that construction covered by this permit application shall not be
commenced until I have received a copy of this application form signed bythe Building
Inspector.
hereby agree to perform the proposed work in accordance with the specifications set
forth above and in accordance with the codes/ordinances of the City of Blair and the
State of Nebraska. I understand thatthis permit is void if work is not commenced within
180 days or is not compllle~~te''d within 2 years of date of issue.
SIGNATURE OF 0 NERICONTRACTOR DATE
Comment:
Site Plan Attached O Complete Plans Attached
pproximate Completion Date ~ 1/V2C~ ~f~~rc~x ~
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
Framin Final ~ !')'~~o " ~~
g
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbing _
Ground Work
Rough-in
WHEN PROPERLY VALIDATED
Approved By: ~,.~_
A\C
Final
THIS SPACE) THIS IS Y MIT
7352
POUNDS PRTG: Blair, NE Rev. 8/96
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